Barnet council is making yet another attempt to attack services to older people in the borough. At the end of 2009 it was stopped from its attempt to withdraw the wardens from all the sheltered housing schemes following a successful legal challenge on grounds of discrimination against disabled people. The High Court ruling was a welcome victory that came after a broad public campaign to defend the sheltered housing wardens, supported by many in the borough.
However, the council is now proposing more changes to the way it provides services to older citizens, including the effective withdrawal of council funded wardens from the sheltered housing schemes. All the proposed changes seem to have a common bottom line – privatisation and charging for services.
Barnet council has recently consulted on two proposals:
1. Sheltered Plus – For older people who are at risk of losing their independence, consisting of Sheltered Plus Services and Sheltered Plus Housing. The former, Sheltered Plus Services, include a personal care element and some home care such as cooking meals and administering medication, which is not part of the services offered under the proposal of ‘menu of charged services’ below; Sheltered Plus Housing, according to this proposal, will include all these services in addition to residency in one of only three sheltered housing schemes in the borough with on-site staff.
2. ‘A “menu” of charged services that older people can purchase [my highlight – T.W.] directly from different providers on a “pay as you go” basis.’ (p. 6, Consultation on Housing & Support for Older People document).
Needless to say, the Sheltered Plus is a chargeable service as is the menu of services.
Let’s examine these proposals, but first let us have another look at the sheltered housing wardens’ issue.
The Sheltered Housing Wardens again
The council states clearly that it will not continue to fund the wardens and that’s its final decision. It claims that despite this decision it had successfully negotiated with independent housing providers (housing associations) the retention of live-in wardens in their schemes, by funding it through ‘enhanced housing management’ rather than through ‘support charge’ as before, as will be explained below.
However, it seems that this does not apply to Barnet Homes schemes, previously council run. That makes one wonder about the differentiation in attitude towards residents of different sheltered housing schemes in the borough. It is clear that it will make it easier for the council to go ahead with the proposed changes despite public objection, and further erode services to older people, if this situation will create different interest groups among residents. There are already several tiers of sheltered housing residents, with different tenancy agreements guaranteeing different levels of entitlement to services, according to the date they joined the scheme. These various entitlements reflect the corrosion already seen in sheltered housing throughout the last few years. However, regardless of these different conditions, so far the borough has seen a united campaign to save the wardens from all the sheltered housing residents, plus solidarity by supporters from the wider community. This united community campaign which accompanied the legal one, is what secured for the time being the victory in the battle on the sheltered housing wardens.
The manipulation around payment for wardens
Payments for ‘housing management’ are part of the rent and service charges in social housing, and normally are used to include things such as maintenance, repairs and management fees. Being part of the rent, they are covered by Housing Benefits. The manipulation around funding the wardens, as mentioned above, is to include the support charges in this category, so it should be covered by Housing Benefits for those residents who are in receipt of it.
There is nothing wrong with this manipulation if it can buy us the publicly funded support for older residents, but any layperson will be excused for wondering what the point of this accountants’ exercise is? After all, isn’t Housing Benefits local authority’s money as is the money that funds the wardens? If that is indeed the case, what difference does it make to the council’s budget whether the support charges are paid under “wardens’ salaries” or under “housing management”?
Whichever it is called, in effect there may be little or no change in the short term for sheltered housing residents who get Housing Benefits, as the charges for the support the wardens provide will simply come from another pocket of the council – under another title.
Yet, there is an unknown element that has to be considered here, and this is how the government’s proposed changes in Housing Benefits will affect those residents whose rent is currently paid by Housing Benefit. When HB payments will decrease and stop covering the full rent, and without the protection of publicly funded wardens – what will happen then to the poorer and more vulnerable older residents of the sheltered housing schemes? Can we trust the council to keep funding the services for those who need it, at the same level of services as now, even if they cannot afford to pay for it?
In any case, according to the council’s figures, about 70% of the sheltered housing residents get Housing Benefits. The other one third of residents are people who saved up higher pensions during their working lives and are paying the rent by themselves. The council is trying to tempt those residents to support its proposals by promising that they will not have to pay anymore for ‘support charge’; however, their rent will be increased by a similar sum to fund the wardens…
So, for the moment, these 30% of independent payers, like their neighbours who receive Housing Benefits, may feel no change in the expense they will have to spend on their sheltered housing rent and services; but, as with any withdrawal of public funding from services, there is no telling of the future increases in rent as a result of this change, and no public monitoring and control of it once it is out of the council’s hands.
‘These wardens are vital for many of our residents’, says Marge Lacey of the Sheltered Housing Partnership Panel. ‘We rely on the wardens. A lot of the people are sick, and although they’ve got carers coming in, they count on the warden to come in within minutes when they need them.’ The danger will be when people start having to calculate whether they can afford paying for the warden’s support or not. Then, surely, the risk to their independence will increase if they are forced to give the warden’s services up because of financial difficulties. That is one example of how losing public services and privatisation may lead to a very real risk to the quality of life and independence of older citizens.
Trying to understand the Sheltered Plus and the Menu of Charged Services proposals in the context of social care services
The local authority has a legal duty of care to vulnerable adults within its area. Both proposals address the range of care provision that constitute fulfilling this duty, and indeed the council proposes to fulfil its duty by offering access and brokerage to social care services.
But since these services are offered for a fee, when we examine the proposals we should ask ourselves what may be bought for this fee: who will determine the level of care, and who will define what needs have to be met? Will we be guaranteed, for instance, that social interaction and freedom from isolation in old age will always be regarded as important, as well as feeding and bathing? Can we trust the council to support true independence of older citizens as is now achieved for those in sheltered housing by the wardens’ services? Or will the council’s social services discharge their duty by addressing only the most basic physical needs of older adults?
The council says they can use the money saved from the wardens’ salaries to take care of all the older people in Barnet. This claim is based on the premise that Adult Social Services’ budget and the budget cuts are a given. But do we accept that this is the case? We may not necessarily accept that money for social care services is short – we may think that it is merely a matter of priorities. And priorities can be changed.
For example, as the councillors themselves admit, following the previous consultation, options were changed. The consultation paper explains that ‘the reason we [the council] are not pursuing option 2 [short term floating support service – T.W.] is because we have listened to residents who were worried about the “temporary” nature of the support being proposed, and instead will be offering longer-term support where needed to those people most at risk through our Sheltered Plus services.’
I would ask the reader to pay attention and hold on to the terms ‘most at risk’ and ‘longer-term’ in the quote above. ‘Most at risk’ appear to suggest that the council is truly concerned about those most vulnerable among us. But, as will be discussed later, I would like to argue that this is a false appearance, because it indicates that they are not concerned enough about all other older people who are less at risk, yet need some help. Indeed, this perspective may lead to negligence by creating circumstances in which people will deteriorate and develop greater risk due to lack of support at the right time, contrary to the council’s rhetoric of supporting older people’s independence. How this approach translates to provision of care to older adults in the community is detailed below.
But, furthermore, even if we focus only on the suggestion that the new proposals offer longer-term (rather than long-term service…), there seems to be a problem with the suitable implementation of it: at least one of the independent service providers the council proposes for support services such as befriending and ‘checking service’ (regular daily or weekly calling or visiting to check that everything is alright, something which is part of the current wardens’ daily routine), offers only a temporary service of 6-9 months (and only during normal working hours, Mon-Fri 9-5). Outreach Barnet, the above mentioned provider, is a joint venture of Notting Hill Housing Association and Homeless Action in Barnet. Their staff member explains that they may take on a client again if and when the need arises – but such voluntary sector organisations cannot sustain very large number of clients for long periods of time and the nature of older people’s needs is such that in many cases there will be a continuous need for support. A temporary support service won’t suffice.
Let us remind ourselves here that even these ‘checking’ and befriending services will not be free. ‘How long you would buy the services for, as well as payment for these, would be between you and the provider’, says the council (p. 16, online Consultation) and exposes the reality old people in Barnet will have to face — of no public control over these services or charges and no public accountability.
In its consultation, the council promises that the care and support services for older people will be good quality and affordable; however, according to the consultation papers, the council ‘have yet to develop’ the menu of charged services, so in effect Barnet older citizens are asked to vote for the privilege to pay for an unknown – an unknown list of services and unknown charges…
The situation with social services for older people
When we examine these two proposals we need to ask: Will they improve the independence and quality of life of the older citizens of Barnet or be another round of limiting services under the attractive name of Fair Access to Care? What will be the criteria for getting the services, apart from the ability to pay for them? And, even then, will anyone with money be able to purchase them, or will they first have to satisfy the full set of criteria, designed to reduce the number of service users?
There is a scary indication that this will be the case on p. 12 in the online consultation document under the title ‘How would people access Sheltered Plus services?’ According to these criteria, one has to be able to live on his or her own but be at a substantial or critical risk of harm and require a minimum number of hours of care and support per week. It seems that these criteria for eligibility for care and support services immediately exclude independent elderly people who need only some help in order to remain active and independent.
In fact, this last point applies to any elderly person who needs support services from the council, and brings us again to the issue of how eligibility for social services is determined, and the framework of Fair Access to Care Services. As part of the ongoing eroding of the welfare state, Adult Social Services are obliged to use this framework to assess people’s needs and determine whether they qualify for the local authority’s support. There are four bands in this framework, covering most aspects of life and reflecting four levels of risk of harm, or risk to independence. Anyone who faces difficulties in their daily lives has a right to be assessed for social care services such as personal and home care, equipment and adjustments to their living conditions.
But what is not known to many people is that these services are already provided only to those who are most vulnerable – who are at substantial or critical risk of harm, not to those older or disabled adults who are at a moderate or low level risk.
Of course this does not make any sense. Consider this: an older person who finds it difficult to do his shopping, for instance, but is perfectly independent in all other respects, would cost the council far less in assistance with his shopping, than if they waited until he is malnourished and ill as a result of not being able to shop for food. However, that is exactly how things are handled. In the first instance this older person is considered to be only at a low level of risk, therefore he will not qualify for public help; when he becomes much frailer and is discharged from hospital he will be deemed as being at a substantial risk and will receive personal care services, home care and perhaps even a referral to sheltered housing, which, obviously, will cost the council far more.
This is yet another example of the waste that getting rid of the welfare state mechanisms imposes. We’ve been enduring corrosion to public services – once provided for all – for a number of years. The welfare state is now facing a further attack with these new proposals.
The Fair Access to Care Services framework reflects a battle around public services we lost some years ago, starting with the Thatcher era and continued under New Labour, when outsourcing and privatisation were let into social services. From a healthy welfare state situation in which social services supported all those in need, we deteriorated to a situation in which a person in need of support may be assessed by social services but nevertheless offered services from other agencies, for example, voluntary or private agencies (London Borough of Barnet’s policy on Needs Assessments: http://www.barnet.gov.uk/needs-assessment#eligibility_criteria), rather than by accountable public services staff.
The recently concluded Consultation on Housing and Support for Older People in Barnet is another attack on the welfare state, on the social achievements that were fought for and begotten by right, on what had been and should be taken for granted.
We pay council tax and other taxes throughout our working life, in order to receive the assistance of our community when we need it. This assistance should not be begged for nor paid for separately. That’s why we have the mechanisms of the local council: to represent all of us, the residents of the community, in the taking care of those of us who become more vulnerable.
The council justifies these latest proposals by arguing that the sheltered housing residents make up only 3% of the older population in Barnet but use 60% of the budget for older people. This argument, meant to ‘divide & rule’ between older residents of sheltered housing and those living in their own homes, is misleading. It shifts the reference point from the desired (and possible!) situation of true welfare state social care provision, as we had previously in this country, and presents as an unavoidable reality the crooked choice of Tory and New Labour ideologists who prioritise profiting from social care over comprehensive and universal provision of care to all those who need it.
We should not forget the real point of reference: the British welfare state with public services for all and not for profit; social care for all who need it and not only for those who can pay. Renewal of this welfare state should be our goal and that is where we should unashamedly aim.